Precision pulse capsulotomy: performance metrics and utility in routine and complex cases

Abstract

Purpose: To evaluate precision pulse capsulotomy (PPC) performance. Setting: University and private practice in the United States and South Korea. Design: Multicenter retrospective analysis. Methods: The surgical videos of 337 cataract surgeries with PPC capsulotomy performed by 4 surgeons at 4 centers were used to assess capsulotomy outcomes including completion rate, diameter, roundness (ovality), and quality of capsular overlap. Results: PPC use resulted in 99.4% free-floating capsulotomies from 337 cases. Video image analysis in a subset (n = 52) yielded a mean capsulotomy diameter of 5.0 mm ± 0.16 mm SD (95% CI, 4.96-5.04 mm). Capsulotomies were round to slightly oval at the end of the case with a mean ovality of 3.0% ± 2.86% (95% CI, 2.22%-3.78%; 360 degrees capsular overlap was obtained in 98% of cases. The offset of the capsulotomy center with the intraocular lens (IOL) optic center was 197 μm ± 122 μm (SD) (95% CI, 148-246 μm). PPC was used successfully in traumatic cataracts with compromised anterior and posterior capsule, phacodonesis, intumescent cataract with constricted pupil, and zonular dialysis and in penetrating keratoplasty with open-sky extracapsular cataract extraction. Conclusions: Surgeons obtained good PPC capsulotomy outcomes in routine and challenging cases. Little variation was observed in achieving free-floating capsulotomies with approximately 5.0 mm diameter and complete capsular overlap. Variation was observed in the amount of offset between the capsulotomy center and the center of the IOL optic. PPC was useful in cases with multiple comorbidities that challenge capsulotomy performance.

Clinical Results After Precision Pulse Capsulotomy

“…Prior experience reported in the literature suggests that complications in early cases are primarily related to not ensuring complete capsule contact or a failure to fully retract the push rod used to insert the device, which can interfere with suction. 15 There are limitations to the current study. While numbers were relatively high, the retrospective nature of the data collected reduced the level of detail that could be extracted from the clinical records.…”

“…13 Previous clinical results have demonstrated the efficacy of the device. [14][15][16] As with the femtosecond laser systems, there is some evidence that an automated capsulotomy that does not induce zonular stress may be helpful in complicated cases. 15 The purpose of the current study was to retrospectively review refractive outcomes and complications in a high number of cases completed using the PPC device, comparing them to a similar set of cases completed using a manual CCC technique.…”

Automated precision pulse capsulotomy vs manual capsulorhexis in white cataracts: reduction in procedural time and resource utilization

“…[11][12][13][14][15] The learning curve has been reported to be favorable, and the experience of 4 surgeons has been described. 11 Several device operating principles underlying PPC creation suggest that this technology may also be useful in cases of white cataract. This includes the technology's ability to function in the presence of poor capsular visibility, the near-instantaneous (4 milliseconds) creation of the whole capsulotomy to rapidly release intralenticular pressure, and the demonstrated added capsular edge strength resulting from PPC's unique cutting effect.…”

“…11–15 The learning curve has been reported to be favorable, and the experience of 4 surgeons has been described. 11…”

“…7 Recently, PPC was introduced for the automated creation of a round, precise capsulotomy during cataract surgery. [8][9][10][11][12] PPC involves the use of a handpiece with a capsulotomy tip composed of a suction cup and an embedded nitinol capsulotomy ring element. The tip is folded and inserted into corneal incisions 2.2 mm or greater and is reexpanded to its original circular shape once introduced inside of the eye.…”